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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2021, Vol. 07 ›› Issue (01) : 13 -18. doi: 10.3877/cma.j.issn.2095-9605.2021.01.003

所属专题： 文献；

论著

减重代谢手术患者腹部脂肪分布与阻塞性睡眠呼吸暂停的相关性研究
赵磊1, 吕晗1, 刘洋2, 李梦伊1, 孙婧2, 刘佳1, 赵鹏飞1, 杨正汉2, 张鹏2, 张忠涛1(), 王振常1,†()   
  1. 1. 100050　北京，首都医科大学附属北京友谊医院放射科
    2. 首都医科大学附属北京友谊医院（国家消化系统疾病临床医学研究中心）普通外科中心减重与代谢外科
  • 收稿日期:2020-08-27 出版日期:2021-02-28
  • 通信作者: 张忠涛, 王振常

Correlation between abdominal fat distribution and obstructive sleep apnea in patients undergoing metabolic and bariatric surgery

Lei Zhao1, Han Lv1, Yang Liu2, Jing Sun1, Jia Liu2, Pengfei Zhao1, Zhenghan Yang1, Peng Zhang2, Zhongtao Zhang2, Zhenchang Wang1,†()   

  1. 1. Department of Radiology, Beijing Friendship Hospital, Capital Medical University
    2. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing 100050, China
  • Received:2020-08-27 Published:2021-02-28
  • Corresponding author: Zhenchang Wang
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引用本文：

赵磊, 吕晗, 刘洋, 李梦伊, 孙婧, 刘佳, 赵鹏飞, 杨正汉, 张鹏, 张忠涛, 王振常. 减重代谢手术患者腹部脂肪分布与阻塞性睡眠呼吸暂停的相关性研究[J]. 中华肥胖与代谢病电子杂志, 2021, 07(01): 13-18.

Lei Zhao, Han Lv, Yang Liu, Jing Sun, Jia Liu, Pengfei Zhao, Zhenghan Yang, Peng Zhang, Zhongtao Zhang, Zhenchang Wang. Correlation between abdominal fat distribution and obstructive sleep apnea in patients undergoing metabolic and bariatric surgery[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2021, 07(01): 13-18.

目的

分析腹部磁共振（MR）图像中腰1-腰2（L1-L2）层面腹腔内脏脂肪（VAT）、腹腔皮下脂肪（SAT）含量及体质量指数（BMI）与阻塞性睡眠呼吸暂停（OSA）的发生及严重程度之间的关系。

方法

选取2017年11月至2019年11月于首都医科大学附属北京友谊医院治疗的代谢综合征患者的临床资料，收集BMI、多导睡眠检测（PSG）、腹部MR结果。分析腹部VAT、SAT的面积、BMI与代谢综合征人群OSA严重程度之间的关系。根据OSA严重程度绘制受试者工作特征（ROC）。

结果

本次纳入研究患者共65例，根据OSA严重程度，分不伴有OSA组、轻度、中重度OSA组。VAT面积与OSA的发生及严重程度有关（P<0.05），中重度OSA组患者的VAT面积较轻度及不伴有OSA组增大，有统计学差异（P<0.05） 。BMI与OSA的发生无关（P>0.05），与OSA严重程度有关，BMI在中重度OSA组中较不伴有OSA组及轻度OSA组中升高（P<0.05）。SAT与OSA的发生及严重程度均无关（P>0.05）。以有无OSA的发生绘制受试者敏感曲线（ROC），曲线下面积（AUC）为0.76，95%CI: 0.63-0.89，（P<0.001）。VAT面积临界值为174.9 cm2，灵敏度为80.5%，特异性为62.5%；以轻度与中重度OSA的发生绘制ROC曲线，AUC为0.84，95%CI: 0.74-0.94,（P<0.001）VAT面积临界值为218.2 cm2，灵敏度为70.5%，特异性为80.5%。

结论

对肥胖人群，要关注VAT的含量，中重度OSA患者中BMI与VAT的升高值得重视。腹部MR扫描利用单一层面VAT面积，分析与OSA严重程度间关系，增进了腹部脂肪在OSA发病中的理解。

关键词: 腹部内脏脂肪, 阻塞性睡眠呼吸暂停, 减重代谢, 磁共振
Objective

Analyze the content of visceral abdominal fat (VAT) and subcutaneous abdominal fat (SAT) at L1-L2 level in abdominal magnetic resonance (MR). Analyze the relationship between abdominal visceral fat (VAT), abdominal subcutaneous fat (SAT), body mass index (BMI) and the occurrence and severity of obstructive sleep apnea-hypopnea syndrome (OSA).

Methods

The clinical data of patients with metabolic syndrome treated in our hospital from November 2017 to November 2019 were selected, and the results of body mass index (BMI), polysomnography (PSG), and abdominal MR were collected. Analyze the relationship between the area of abdominal VAT, SAT, BMI and the severity of OSA in the metabolic syndrome population. Draw receiver operating characteristics (ROC) based on OSA severity.

Results

A total of 65 patients were included in the study. According to the severity of OSA, the patients were divided into three groups: non OSA group, mild OSA group, moderate-to-severe OSA group. The area of VAT was related to the occurrence and severity of OSA (P<0.05). The area of VAT in patients with moderate-to-severe OSA was larger than that in the group without OSA and mild OSA group (P<0.05). BMI was not related to the occurrence of OSA (P>0.05), but related to the severity of OSA. BMI in moderate-to-severe OSA group was significantly higher than that in non OSA group and mild OSA group (P<0.05). The area of SAT was not related to the occurrence and severity of OSA. According to the ROC plotted with or without OSA, the area under curve (AUC) is 0.76, 95%CI: 0.63-0.89, P<0.001. The cut-off value of VAT area is 174.9 cm2, the sensitivity is 80.5%, and the specificity is 62.5%. According to the ROC plotted mild or moderate-severe OSA, the AUC is 0.84. The cut-off value of VAT area is 218.2 cm2, the sensitivity is 70.5%, and the specificity is 80.5%.

Conclusions

It is important to pay attention to the content of VAT in patients with moderate-to-severe OSA in the weight-loss metabolic population. The increase of BMI and VAT area in patients with moderate-to-severe OSA deserves attention. Abdominal MR scans use a single-level VAT area to analyze the relationship with the severity of OSA, which improves the understanding of abdominal fat in the pathogenesis of OSA.

Key words: Visceral adipose tissue, Obstructive sleep apnea, Metabolic and bariatric surgery, Magnetic resonance
图1 横断面的脂肪成分见图。1A：L1-L2层面MR原始图；1B：脂肪面积标注示意图，红色标注区域为SAT面积，绿色标注区域为VAT面积
表1 患者临床资料信息
  不伴有OSA组 伴有OSA组 P值*
轻度OSA组 中重度OSA组
年龄（岁） 33.8±11.0 35.8±5.9 35.5±8.9 0.43
性别（男/女） 3/21 3/14 11/13  
BMI（kg/m2） 36.8±5.4 36.8±6.7 42.1±6.1 0.06
SAT面积（cm2） 313.75±130.1 340.1±155.4 380.3±137.7 0.17
VAT面积（cm2） 179.4±74.0 195.4±44.9 277.9±71.1 0.001
图2 OSA严重程度与患者VAT面积、SAT面积及BMI间的关系
图3 VAT面积与有无OSA间的ROC曲线（AUC=0.76，95% CI: 0.63-0.89，P<0.001）。临界值为174.9 cm2，灵敏度为80.5%，特异度为62.5%）
图4 VAT面积与中重度OSA间的ROC曲线（AUC=0.84，95%CI:0.74-0.94，P<0.001），临界值为218.2 cm2，灵敏度为70.5%，特异度为80.5%）
图5 腹部脂肪分布差异示意图。5A：VAT面积128 cm2，SAT面积298 cm2，BMI 38.0 kg/m2；5A：VAT面积176 cm2，SAT面积206 cm2，BMI 30.4 kg/m2；5C：VAT面积219 cm2，SAT面积338 cm2，BMI 44.6 kg/m2；5D：VAT面积288 cm2，SAT面积435 cm2，BMI 45.3 kg/m2
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